Department of Medicine, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Department of Medicine, St. George's University School of Medicine, Grenada, West Indies.
Heart Rhythm. 2018 Jul;15(7):1001-1008. doi: 10.1016/j.hrthm.2018.02.019. Epub 2018 Feb 17.
Recommendations regarding performance of magnetic resonance imaging (MRI) in non-MRI conditional pacemaker and defibrillator recipients are evolving. Previous studies have suggested low adverse event rates with MRI in nonconditional cardiac implantable electronic device (CIED) recipients, but low power limits optimal characterization of risk.
The purpose of this study was to perform a systematic review and meta-analysis to characterize the clinical risk associated with MRI in CIED recipients in order to improve power.
PubMed and CINAHL indexed articles from 1990 to 2017 were queried. A random effects model was used for meta-analysis of continuous variables. Safety outcomes were evaluated with descriptive statistics.
Seventy studies of non-MRI conditional devices undergoing MRI were identified, allowing for analysis of 5099 patients who underwent a total of 5908 MRI studies. Heterogeneity in lead parameter changes was observed within studies, although smaller variances were noted between studies. All lead characteristics and battery voltages showed very small, clinically insignificant changes when assessed as a pooled cohort, although cases of clinically relevant outcomes were also noted (lead failure 3, implantable cardioverter-defibrillator shock 1, electrical reset 94). Electrical resets were found only in older devices. Defibrillator function was unchanged, and inappropriate shocks were avoided with pre-MRI programming changes.
This review demonstrated low lead failure and clinical event rates in non-MRI conditional pacemaker and defibrillator recipients undergoing MRI. Observed changes were small and interstudy variance was low, suggesting that the composite event rates offer a reasonable estimate of true effect. The observed adverse events reinforce the need for ongoing vigilance and caution, particularly with older devices.
关于非磁共振条件下起搏器和除颤器接受者进行磁共振成像（MRI）的建议正在不断发展。先前的研究表明，非条件性心脏植入式电子设备（CIED）接受者行 MRI 的不良事件发生率较低，但低功率限制了对风险的最佳评估。
本研究旨在进行系统评价和荟萃分析，以描述 CIED 接受者行 MRI 相关的临床风险，从而提高效能。
检索了 1990 年至 2017 年期间 PubMed 和 CINAHL 索引的文章。采用随机效应模型对连续变量进行荟萃分析。采用描述性统计评估安全性结果。
确定了 70 项非 MRI 条件设备行 MRI 的研究，可对 5099 例共行 5908 次 MRI 检查的患者进行分析。尽管研究之间的差异较小，但研究内观察到导丝参数变化存在异质性。当作为一个汇总队列进行评估时，所有导丝特征和电池电压均显示出非常小的、临床意义不大的变化，但也注意到了一些临床相关的结果（导丝故障 3 例、植入式心脏复律除颤器电击 1 例、电重置 94 例）。仅在较旧的设备中发现电重置。通过 MRI 前编程更改避免了不必要的电击，且除颤器功能未改变。
本综述表明，非 MRI 条件下起搏器和除颤器接受者行 MRI 后，导丝故障和临床事件发生率较低。观察到的变化较小，且研究间差异较低，这表明复合事件发生率提供了真实效应的合理估计。观察到的不良事件强化了持续警惕和谨慎的必要性，特别是在使用较旧设备时。
